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Chief Medical Officer

Minneapolis, MN, USA | Leading Healthcare - Hospitals Company

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    Biotech/R&D/Science
  • Experience:
    3-5 years
Job Description:
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The Chief Medical Officer is responsible for three major areas: 1) overseeing the clinical teams that operate within Clinical Operations and establishing a clear strategy and direction for their work; 2) in concert with the Clinical Market Performance team establish effective external relationships with health system physician leaders focused on establishing and executing against market population health, risk, and quality targets, and 3) direct oversight and leadership of risk adjustment, and quality/Stars teams and goals.

YOUR RESPONSIBILITIES

Establish the strategy for population management for each line of business in each market. In addition, establish the tenets of our overarching population health, risk adjustment, and quality/Stars strategies at Leading Healthcare - Hospitals Company.

Represent Leading Healthcare - Hospitals Company externally at selected conferences, in key professional bodies, with Care Partner clinical and other executive leadership, with media and in other venues.

Establish the strategy and oversee the medical functions of the utilization review and quality assurance—you will not be responsible for operationalizing the technology, teams, and reporting for these functions.

Build and manage a team of clinical experts to ensure effective population health management and Care Partner interactions in collaboration with the Clinical Market Performance team.

Lead Leading Healthcare - Hospitals Company’s clinical staff directly or through dotted line relationships; recruit and assist in the recruitment of key clinical staff.

Support population health staff to ensure timely and consistent responses to members and Care Partners.

Act as lead business and clinical liaison to network providers and facilities to support the effective execution of population health, risk adjustment, and quality/Stars programs

Provide oversight and business direction for the following activities, including but not limited to:

Formulary development

Pharmacy and Therapeutics management

Credentialing

Utilization Management

Clinical Compliance

Quality Management and Programs

Risk Accounting Programs

Appeals and Grievances Review

Network Management and Evolution

Provider Relations

Market-level clinical management and program development

Provides clinical consultation to departments outside Health Optimization, including

Network

Operations

Customer Experience

Care Partner Integration

Marketing

Communications

Participate the establishment of path-to-value activities with Care Partners leading to value based payment models.

Oversee clinical teams and vendors in partnership with the Population Health Operations team to ensure timeliness in meeting all required Federal and State turnaround time on clinical decision making, including but not limited to: Decision reviews that must occur within 6 hours on occasion as demanded by state and federal guidelines. Ability to participate in second review of group decision must often occur in 24 hours

Periodically consults with other practitioners in the field.

SUPERVISORY RESPONSIBILITIES

This position has supervisory responsibilities for the all Medical Directors and the Vice President and of Stars, Quality, and Risk Adjustment.

EDUCATION, TRAINING AND PROFESSIONAL EXPERIENCE

Bachelor’s degree required; Master of Public Health (MPH), Master of Health Administration (MHA) or Master of Business Administration (MBA) is preferred

Three or more years of experience in Clinical Practice and/or Health Care Industry is required.

Three or more years of direct clinical care in private and/or academic practice that includes oversight of direct patient care is required.

Post-graduate experience in direct patient care is required.

Previous leadership experience in a clinical oversight role is required.

Previous Medicare and/or Commercial insurance industry experience preferred.

PROFESSIONAL COMPETENCIES

Ability to meet all required Federal and State turnaround time on clinical decision making, including but not limited to; decision reviews that must occur within 6 hours on occasion as demanded by state and federal guidelines.

Ability to participate in second review of group decision must often occur within 24 hours

Demonstrated knowledge of established medical management and clinical services.

Strong interpersonal and communication skills.

Commitment to carrying out professional responsibilities and an adherence to ethical principles.

WORK ENVIRONMENT

Most work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.


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